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Flashcards in Smoking Deck (8)
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Does smoking really deserve its own chapter in this book?

Smoking is the single most significant source of preventable morbidity and premature death in the United States.

*this is a recurrent theme on the USMLE, so whenever you are not sure which risk fac- tor to choose to reduce morbidity or mortality, smoking is a safe guess*


How is smoking related to heart disease?

Smoking is responsible for 30% to 45% of such cardiac-related deaths in the US.

This risk is decreased by 50% within 1 year of quitting, and by 15 years after quitting, the risk is the same as for someone who has never smoked.


What cancers are more likely in smokers?

Almost every part of the body:

  • lung (smoking causes 85%-90% of cases)
  • oral cavity (90% of cases)
  • larynx
  • pharynx
  • esophagus (70%-80% of cases)
  • stomach
  • colon
  • rectum
  • bladder (30%-50% of cases)
  • kidney (20%-30%)
  • pancreas (20%-25%)
  • cervix


Describe the effect of smoking on the lung.

  • Lung cancer
  • chronic obstructive pulmonary disease (COPD; emphysema, chronic bronchitis, and bronchiectasis)
    • Emphysema almost always results from smoking; if the patient is very young or has no smoking history, you should consider alpha1-antitrypsin deficiency. Although the changes of emphysema are irreversible, the risk of death still decreases if the patient stops smoking.


What about second-hand smoke?

Second-hand smoke is a proven risk factor for lung cancer and other lung disease; risk increases linearly with increasing exposure.

When parents smoke, their exposed children are at an increased risk for asthma and URIs, including otitis media.


What other bad things does smoking do?


  • retards the healing of PUD
  • increase risk of Buerger disease (thromboangiitis obliterans - vasculitis of small/medium sized arteries and veins, results in ischemic claudication of extremities and may subsequently lead to paresthesias/ulceration/gangrene)
  • increases the risk of low birth weight, prematurity, spontaneous abortion, stillbirth, and infant mortality
  • Cessation of smoking pre-op is the best way to decrease the risk of post-op pulmonary complications, especially if it is stopped at least 8 weeks before surgery.


True or false: Women who smoke cannot take birth control pills.


if the woman is > 35 yo + smokes OR  < 35 years + smokes > 15/day, the risk of thromboembolism is increased sharply if they take OCPs.

Postmenopausal women, however, can take estrogen therapy regardless of smoking status.


So what is the bottom line for the boards?

Smoking is a very dangerous habit that should be avoided.